A 6-year-old child presents with daily episodes of sudden brief staring, with eye blinking and lip smacking lasting 5-10 seconds. The child is unaware of these episodes, which resolve spontaneously. EEG shows 3 Hz spike-and-wave complexes. Which of the following antiepileptic drugs is considered first-line for childhood absence epilepsy?

• A Carbamazepine
• B Phenytoin
• C Phenobarbitone
• D Ethosuximide ✓

Explanation

Childhood absence epilepsy with classic 3 Hz spike-and-wave EEG pattern is treated first-line with ethosuximide (blocks T-type calcium channels in thalamic neurons, which generate the 3 Hz discharge). Valproate is equally effective but has more side effects and teratogenicity. Lamotrigine is a second-line option. Carbamazepine and phenytoin are not only ineffective for absence seizures but may paradoxically worsen them. Phenobarbitone is ineffective for absence epilepsy. The CHILD study confirmed ethosuximide as first-line with better tolerability than valproate.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.